Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Pittsburg Medical Center, Harrisburg, PA (Sigdel).
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University in St. Louis, St Louis, MO (Burd).
Am J Obstet Gynecol MFM. 2024 Aug;6(8):101407. doi: 10.1016/j.ajogmf.2024.101407. Epub 2024 Jun 14.
This study aimed to evaluate if induction of labor (IOL) is associated with an increased risk of severe perineal laceration.
A systematic search was conducted in MEDLINE, Ovid, Scopus, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and CINHAL using a combination of keywords and text words related to "induction of labor," "severe perineal laceration," "third-degree laceration," "fourth-degree laceration," and "OASIS" from inception of each database until January 2023.
We included all randomized controlled trials (RCTs) comparing IOL to expectant management of a singleton, cephalic pregnancy at term gestation that reported rates of severe perineal laceration.
The primary outcome of interest was severe perineal laceration, defined as 3rd- or 4th-degree perineal lacerations. We conducted meta-analyses using the random effects model of DerSimonian and Laird to determine the relative risks (RR) or mean differences with 95% confidence intervals (CIs). Bias was assessed using guidelines established by Cochrane Handbook for Systematic Reviews of Interventions.
A total of 11,187 unique records were screened and ultimately eight RCTs were included, involving 13,297 patients. There was no statistically significant difference in the incidence of severe perineal lacerations between the IOL and expectant management groups (209/6655 [3.1%] vs 202/6641 [3.0%]; RR 1.03, 95% CI 0.85, 1.26). There was a statistically significant decrease in the rate of cesarean birth (1090/6655 [16.4%] vs 1230/6641 [18.5%], RR 0.89, 95% CI 0.82, 0.95) and fetal macrosomia (734/2696 [27.2%] vs 964/2703 [35.7%]; RR 0.67: 95% CI 0.50, 0.90) in the IOL group.
There is no significant difference in the risk of severe perineal lacerations between IOL and expectant management in this meta-analysis of RCTs. Furthermore, there is a lower rate of cesarean births in the IOL group, indicating more successful vaginal deliveries with similar rates of severe perineal lacerations. Patients should be counseled that in addition to the known benefits of induction, there is no increased risk of severe perineal lacerations.
本研究旨在评估引产（IOL）是否与严重会阴裂伤风险增加相关。
通过组合与“引产”、“严重会阴裂伤”、“三度裂伤”、“四度裂伤”和“OASIS”相关的关键字和文本词，在 MEDLINE、Ovid、Scopus、ClinicalTrials.gov、Cochrane 对照试验中心注册库和 CINHAL 中进行了系统搜索，每个数据库的起始时间为成立至 2023 年 1 月。
我们纳入了所有比较 IOL 与单胎、足月、头位妊娠期待管理并报告严重会阴裂伤发生率的随机对照试验（RCT）。
主要结局是严重会阴裂伤，定义为 3 度或 4 度会阴裂伤。我们使用 DerSimonian 和 Laird 的随机效应模型进行了荟萃分析，以确定相对风险（RR）或均数差值及其 95%置信区间（CI）。使用 Cochrane 干预系统评价手册制定的指南评估偏倚。
共筛选出 11187 个独特的记录，最终纳入 8 项 RCT，涉及 13297 名患者。IOL 组与期待管理组严重会阴裂伤发生率无统计学差异（209/6655 [3.1%] vs 202/6641 [3.0%]；RR 1.03，95%CI 0.85，1.26）。IOL 组剖宫产率（1090/6655 [16.4%] vs 1230/6641 [18.5%]，RR 0.89，95%CI 0.82，0.95）和胎儿巨大儿发生率（734/2696 [27.2%] vs 964/2703 [35.7%]；RR 0.67：95%CI 0.50，0.90）有统计学意义降低。
在本 RCT 荟萃分析中，IOL 与期待管理的严重会阴裂伤风险无显著差异。此外，IOL 组剖宫产率较低，表明阴道分娩成功率更高，严重会阴裂伤发生率相似。应告知患者，除了已知的诱导分娩益处外，严重会阴裂伤的风险并未增加。
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